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Home My WebLink About6866-z FO~I~ NO. 2 TOW~ OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 6866 Z Dote ........................ ::,, .............................. , 19 ........ Permission is hereby granted4~¢~,~ ._ ~' , , ...~,.r..~.~.~.~......>...~. ~ ,~~'~'"""~'~ ...~.2.i~.. ~.:?2~_.....~.~4z.._z~.~ -- ..... ~o ............ ..c. ~..,~. ~z~..~.~. ....... ~ ~. ~. ~.. ~ ~.d...,,/,z.~z ~. ~: ! .~..:.?.~.~) at premises located at ....... ........ ...~...-..h~.....-~....C.-~.....~.~.......-. ..................... ' ................. ...........................................................~.~;..z.~._~. ..~........z. Az...~- ~ ........... ~. .................. ...................................................... .~ .. . .. ............... ;~ ......... ~ .................. ~. ... .................................... pursuant to application d~te'd ...... ..~..,~....~...: ........ ./.J:::" ........ , 19~.~.'.., dr~::l a~proved by the Buil~ Inspector. ~/ ~,~ ~---~ Fee ~., ..................... TOWN OF SOUTHOLD ~'~~~ BUILDING DEPARTMENT ~~.~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined I r ~J Application No ................................ Approved ............; .............. .'. ......... , 19 ........ Permit No....'~.....: ........................... Disapproved a/c .................................... ~ .................................................. ............................................................. ¥;;! ......... , ...................................... ,. ,, APPLICATION FOR BUILDING PERMIT Date .... ~.~..:] ..... .,/...:?. .......... 19...?..'''~' INSTRUCTIONS a. This apphcahon must be completely filled m by typewriter or m ink and submitted in triplicate to the Buildins Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relahonship to adjo,mng premises or public streets o areas, and giving a detailed descriplion of layout ofproperty must be drawn on the diagram which is part of this application c. The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d Upon approval of this apphcabon, the Building Inspector wdl ~ssue a Budding Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or ~n pa rt for any purpose whatever until a Certificate of Occupanc, shall have been granted by the Building Inspector. APPLICATION IS HEREBY &GA, DE to the Budding Department for the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construchon of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of apphcant, or nome, if a corporation) ............ pp' ) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ...... .x~.~..~.~-.....-~... ...... ~ ...... ~...~.~...?.~..D .................................................................. If opphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L~cense No .................................................... Plumber's License No ................................................ Electrician's License No ............................................. Other Trade's License No .............................................. Locobon of land on which proposed work will be done~ Map No.: ..... ~...~..~. ........................ Lot No....~.. ..... (...~..~r~.. Street and Number ..... ~ ...... .-~..~'~>,...~.~.d' ............... ~.~.7~./..~..~,..~...~ ................................................... - - Municipality State existing use and occupancy of premises and in*ended use and occupancy of proposed construchon: a Exisiting use and occupancy ...... ~ ~.4;~.~...~,;~.;/.. ~..7.......~. ' .~,~->~/~'7. ~Z~'.r~~/ / ........ .~ .............. b Intended use and occupancy ............ 3 Nature of work (check which apphcable). New Budding .................. Addition .................. Alteration ....... Repair .................. Removal .................. Demolit,on .................. Other Work ~~..~-~ ..~...~..~.,6.6Z ,~ ~ ~ (13lescr;ption) 4. Estimated Cost ......... ................................... Fee ..~...~....~ .................................................... (to be pa~d on filing this apphcation) 5. If dwelhng, number of dwelhng umts ............................ Number of dwelhng umts on each floor .................... If garage, number of cars ................................................................................................................... 6 ~f business, commercia~ or mixed occupancy, specify nature and extent of each type of use ....................... 7 Dimensions of existing structures, if any: Front ............................ Rear ........................... ~ ....Depth ................... Height ........................ Number of Stones ................................................................................................... Dimensions of same structure with alterahons or additions. Front .................................. Rear Depth ................................Height .......................... Number of Stones ......................... 8. Dimensions of entire new construction: Front ............................. Rear ............................ Depth ..... Height ............ ~ ..... Number of Stories ............................................................. 9 Size of lot Front /c~ o ,4~ Rear ,'~O ~ Depth ...z'...6.-.~.....~. ......... 10 Date of Purchase ............. 5' ./..c} ~ .(.4.... Name of Former Owner ..C~ .... 1 1. Zone or use district ~n which premises are s~tuated .............. .'....~f~.....'. .................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation: ..... ~..r_Q .............................. 13 Will lot be regraded ............................ ~/ ~ ,~, ,-Will excess fill be removed from premises: ( ) Yes ('~ No 14 Name of Owner of prem,ses .~...~.~.~...../~...~.~..~.~...x~..~..~..~, ...... Address .~.¢2.f~...~..~.~?...?..~... Phone No. Name of Architect ............................................ Address ................................Phone No ...................... Name of Contractor .................................................. Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~mens~ons fron property lines G~ve street and block number or descriphon according to deed, and show street names and indicatr whether interior or corner lot STATE OF above named He is the ...... ~.:~...2.(~'~..~ ............................................................................................................. (Contractor, agent, corporate officer, etc ) of sa,d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this application, that all statements contained m this application are true to the best of his knowledge and belief, tha~ the work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this ....... ./..:.. ........ N ora ~.~Pu b hc, ..~,~~ ............County .. '- JANET L. NOTARY FUBLI¢, Ste4e o~ Hew York E~plres M~ch (Signature of apphcant)